Evidence based Addiction Residential treatment

[PikminOC]

There are many pop up addiction treatment programs. Can the people of SDN please help me with the evidence based residential treatment programs? Thank you.

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[dl2dp2]

Few exist because the evidence in using the residential treatment in substance abuse is very thin. E.g. there's virtually no RCT in this area.

In general, I tell my patients that treatment assignment is primarily guided by clinical judgement.

 

[PikminOC]

Few exist because the evidence in using the residential treatment in substance abuse is very thin. E.g. there's virtually no RCT in this area.

In general, I tell my patients that treatment assignment is primarily guided by clinical judgement.

Where do you recommend?

 

[dl2dp2]

Where do you recommend?

I don't. Haven't recommended a residential facility for years. I only recommend outpatient MAT maintenance programs or detox. I'm even dubious on the utility of IOP/PHPs. IOPs are useful for co-morbid patients who need a specific thing (i.e. DBT), but I've never seen people who do IOPs who can't do better at a twelve-step plus outpatient therapy for pure SUDs.

People ask me to recommend, and I say why don't you find one yourself, as long as you stay on meds I'm fine with it. I have no recommendation for people who want to be voluntarily locked up for 6-12 months.

They are also very polarizing: parents often find something and insist on their kid go to it. The kids hate it, and if you recommend it to the parents the kids blame you for locking them up. Then the kid comes out and relapses immediately. The parents gonna blame you. I ain't taking any of that responsibility.

Residential programs are also bigly consolidating. One that exists today might not exist tomorrow. See: AAC.

 

[PikminOC]

What do you think of sober living?

 

[dl2dp2]

What do you think of sober living?

No evidence of efficacy (vs usual outpatient care). Wildly variable in services. I usually stay neutral: if patients feel strongly about them I wouldn't push them away, and I suggest it as an option (of unclear evidence) if other strategies have failed. Just standard risk/benefits discussion.

Vs. inpatient/residential programs that are anti-medication (i.e. "med-free rehab"). I steer the parents/patients away. This actually used to be the norm, but thankfully with lawsuits and what not and large chains embracing MAT they have decreased in prevalence.